<%@ page language="java" contentType="text/html; charset=UTF-8"
    pageEncoding="UTF-8"%>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core" %>
<%
String path = request.getContextPath();
String basePath = request.getScheme()+"://"+request.getServerName()+":"+request.getServerPort()+path+"/";
%>
<!DOCTYPE html>
<html lang="en">
<base href="<%=basePath%>">
<head>
    <meta charset="UTF-8">
    <title>Document</title>
    <link rel="stylesheet" href="css/fileImage.css" />
</head>

<body>
	<div style="padding:15px 30px">
		<form id="patientRechargeRecordForm" method="post">
			<input name="id" type="hidden">
			<div style="margin-bottom:18px">
			    <input id="patientid" class="easyui-combobox" name="patient.id" style="width:100%;" data-options=" 
			      url:'patient/patientall',
			      valueField:'id', 
			      textField:'name', 
			      label: '病人'
			      ">
			</div>
	        <div style="margin-bottom:18px">
	            <input class="easyui-textbox" id="money" name="money" style="width:100%" data-options="label:'充值金额:',required:true,missingMessage:'充值金额:必须填写'">
	        </div>
	        <div style="margin-bottom:18px">
	        	<label class="textbox-label textbox-label-left" for="paymentMethodid" style="text-align: left; height: 26px; margin-left:15px; width:55px; line-height: 26px;">支付方式:</label>
			    <input id="paymentMethod" class="easyui-combobox" name="paymentMethod.id" style="width:150px;" data-options=" 
				      url:'dictionary/selectValueByKey', 
				      valueField:'id', 
				      textField:'value', 
				      panelheight:'auto',
				      labelposition: 'top',
					  queryParams: { key: 'zhifufangshi' }
			     ">
	        </div>
			<div style="margin-bottom:18px">
				<input class="easyui-textbox" id="remarks" name="remarks" style="width:100%" data-options="label:'充值说明:'">
			</div>
		</form>
	</div>
</body>
</html>